<?php
/* @var $this HistClaimController */
/* @var $model HistClaim */
/* @var $form CActiveForm */
?>

<div class="wide form">

    <?php $form=$this->beginWidget('bootstrap.widgets.TbActiveForm', array(
	'action'=>Yii::app()->createUrl($this->route),
	'method'=>'get',
)); ?>

					<div class="row">
					<div class="col-sm-3 col-xs-12 bs-docs-sidebar">
					<label class="control-label" for="HistClaim_policy_no">
					No Polis
					</label>
					<div class="controls">
					<input id="HistClaim_policy_no" class="form-control input-width-large" type="text" name="HistClaim[policy_no]" maxlength="200">
					</div>
					</div>
					
					<div class="col-sm-3 col-xs-12 bs-docs-sidebar">
					<label class="control-label" for="HistClaim_policy_no">
					Nama Klien
					</label>
					<div class="controls">
					<input id="HistClaim_nota_debet_no" class="form-control input-width-large" type="text" name="HistClaim[nota_debet_no]" maxlength="200">
					</div>
					</div>
					
					<div class="col-sm-3 col-xs-12 bs-docs-sidebar">
					<label class="control-label" for="HistClaim_createdtime">Tanggal Input</label>
					<div class="controls">
					<input id="HistClaim_createdtime" class="form-control input-width-small" type="text" name="HistClaim[createdtime]" data-mask="99-99-9999">
					</div>
					</div>
					
					</div>

        <div class="form-actions">
		<button class="btn btn-success" name="yt0" type="submit">Search</button>
		</div>

    <?php $this->endWidget(); ?>

</div><!-- search-form -->